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Risk factors and clinical responses of pneumonia patients with colistin-resistant Acinetobacter

Hande Aydemir1, Hande Idil Tuz2, Nihal Piskin2

  • 1Department of Infectious Diseases and Clinical Microbiology, Zonguldak Bulent Ecevit University, Faculty of Medicine, Zonguldak 67100, Turkey. drhaydemir@yahoo.com.

World Journal of Clinical Cases
|June 12, 2019
PubMed
Abstract

Insights

Nosocomial infections with carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (ABC) strains pose a significant threat. While colistin resistance is rare, identifying risk factors is crucial as colistin is often the last resort for extensively drug-resistant ABC pneumonia.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Microbiology

Background:

  • Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (ABC) strains are a major challenge in intensive care units.
  • ABC strains exhibit resistance to multiple antibiotics, with carbapenem resistance being common and colistin resistance rare in many regions.
  • Understanding risk factors for colistin resistance is vital, as colistin is often the sole remaining therapeutic option for severe ABC infections.

Purpose of the Study:

  • To compare clinical responses and outcomes in pneumonia patients with colistin-susceptible versus colistin-resistant Acinetobacter sp. strains.
  • To identify independent risk factors associated with colistin resistance in Acinetobacter sp. infections.

Main Methods:

  • Retrospective analysis of 108 patients with colistin-susceptible strains and 16 with colistin-resistant strains.
  • Statistical comparison using Mann-Whitney U test for continuous variables and chi-square tests for categorical variables.
  • Development of a binary logistic regression model to determine independent factors for colistin resistance.

Main Results:

  • High Acute Physiology and Chronic Health Evaluation II scores (OR=1.9) and prior teicoplanin use (OR=8.1) were independent risk factors for colistin-resistant Acinetobacter sp. infections.
  • While microbiological cure duration was longer in the colistin-resistant group, clinical, laboratory, radiological, and mortality outcomes did not differ significantly between groups.
  • Antibiotic combinations including sulbactam showed high clinical (6/7) and microbiological (5/7) response rates in patients with colistin-resistant strains.

Conclusions:

  • Optimal therapy for colistin-resistant Acinetobacter sp. infections remains unclear.
  • Combinations including sulbactam demonstrated potential effectiveness in this study, though supporting data is limited.
  • Further research is needed to establish evidence-based treatment guidelines for these challenging infections.
Keywords:
Acinetobacter baumanniiColistinVentilator-associated pneumonia

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